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HIV outcomes, savings are improved by state-purchased insurance plans

Preventing the spread of infections could save as much as $41 million in healthcare costs and improve outcomes for those living with the virus.

Jeff Lagasse, Associate Editor

Health insurance purchased by state AIDS Drug Assistance Programs for people living with HIV in states that did not expand Medicaid are improving outcomes and have the potential to save millions in healthcare costs, a new study suggests.

It urges efforts to increase enrollment in the programs, believing that they can even reduce new HIV transmissions.

The researchers examined Affordable Care Act Qualified Health Plans to determine if people living with HIV who enrolled in them have better outcomes. Specifically, they looked at the percentage of patients who reached what is known as "viral suppression," in which the presence of HIV is reduced to undetectable levels in the blood.

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They found that 86% of enrollees reached that desirable health benchmark, while only 80% of non-enrollees did so.

To make that assessment, the researchers looked at 7,776 patients in Nebraska, South Carolina and Virginia -- states that did not expand Medicaid during the time period in question. The patients were 18 to 64 years old, did not have Medicare and were eligible to enroll under their state's guidelines. More than 70% had incomes less than 138% of the federal poverty line, meaning they would have been eligible for Medicaid had their state expanded it at that time.


Overall, 52% of the patients were enrolled in Qualified Health Plans by January 1, 2015. In Virginia, 63% of patients enrolled, while 51% enrolled in Nebraska and only 34% enrolled in South Carolina. The researchers speculated that the high rate in Virginia may have resulted from centralized efforts by the state Department of Health.

There were no significant differences in enrollment based on age, gender, race/ethnicity, income and other such factors, which the researchers called "reassuring," since it benefited people across various demographic groups and didn't contribute to outcome disparities.

This suggests increasing enrollment in Qualified Health Plans would be beneficial. The findings indicate that for every 20 new people enrolled, one likely will reach viral suppression, at which point the virus is difficult to transmit. This could translate into certain benefits such as patients living longer, healthier lives, and improved public health in terms of decreasing HIV transmission.

Every averted HIV case saves up to $402,000 in healthcare costs, results showed. If all eligible people living with HIV and receiving support from a state AIDS Drug Assistance Program were to enroll in a Qualified Health Plan, those achieving viral suppression would increase 2.4%, prevent more than 100 infections and save a combined $41 million in healthcare costs.


The U.S. Department of Health and Human Services has made it a goal to end the HIV epidemic by 2030, and in December it announced a new initiative to help to meet that end: The Ready, Set, PrEP program, which will make pre-exposure prophylaxis (or PrEP) medications available at no cost for qualifying patients.

PrEP medications, such as Truvada and Descovy, are prescription drugs people take daily to reduce their risk of acquiring HIV through sex, and they work by preventing the HIV virus from taking hold and spreading throughout the body.

HHS will initially be covering the costs of dispensing medication, but after March 30, CVS Health, Walgreens and Rite Aid will be donating their pharmacy dispensing services to the government agency, allowing consumers access to free PrEP medications either in person or via no-cost delivery by mail. Patients will also have access to counseling and steps to promote medication adherence.

Twitter: @JELagasse

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